Aspirin use in the prevention of cardiovascular events.

Background: Cardiovascular disease (CVD) is the leading cause of death in the United States and Oklahoma, and Oklahoma ranks 50th in CVD deaths. This paper will describe CVD and coronary heart disease (CHD) mortality in Oklahoma and review current recommendations regarding aspirin use for the prevention of CHD events.

Methods: The CDC Compressed Mortality File for 1999-2004 was accessed. Average annual age-adjusted or age-specific death rates per 100,000 population were calculated. A literature review of data and recommendations regarding aspirin use was conducted.

Results: From 1999-2004, there were 50,170 CHD deaths in Oklahoma (age-adjusted rate 232.1 per 100,000). Persons 75 years and older, males, and blacks had the highest death rates; the death rates declined for all persons except those aged 35-54 years. Aspirin use has been shown to be effective in reducing the number of nonfatal myocardial infarction (MI) and fatal CHD, though studies of aspirin effects in women have found a significant reduction in ischemic stroke but no significant effect on fatal or nonfatal MI or CVD death. Aspirin use slightly increases rates of gastrointestinal bleeding and hemorrhagic stroke.

Conclusion: Continued commitment to counseling patients regarding tobacco cessation, nutrition and exercise, and treatment to reduce blood pressure, cholesterol, tobacco use, and blood sugar are essential. The Oklahoma State Medical Association Physicians Campaign for a Healthy Oklahoma has made it a priority to increase awareness of the risk and benefits of aspirin use among high-risk persons. Oklahoma physicians should assess patients at highest risk, such as healthy men older than 40 years, postmenopausal women (especially >or= 65 years), and younger people with risk factors for coronary heart disease (e.g., hypertension, hyperlipidemia, diabetes, or smoking) and discuss the potential benefits and harms of aspirin use.